The patient came to the clinic 17-July-2012 complaining of drop right wrest and hand after injection to the right radial nerve at the elbow level 2 months ago. She has headache and tinnitus for 6 years and fainting attacks for 3 months. The patient is a known diabetic with arterial hypertension.

On examination, the patient has tinnitus right ear and pain when looking up and down and fainting when looking to the right. She has drop right wrest and hand. There is painful mass when palpating the radial nerve at the elbow level.

MRI cervical spine done 25-July-2012 showing spondylolisthesis C4-5 and small extrusion C5-6. MRI of the brain showed scattered lacunar infarctions both cerebral hemisphere, periventricular more in the left side. EMG and ECS done 250July-2012 confirming non-function of the right radial nerve and severe carpal tunnel syndrome right side.

The right radial nerve was identified and explored at the entire length of the lower third of the arm and upper third of the forearm. There was no proper neuroma and the nerve was adherent with the surrounding structures. There was only motor response when using 8 mA DNS using ISIS Inomed EMG. After neurolysis of the nerve to the healthy portions proximally and its branches distally, the nerve could achieve response with 2 mA DNS. Even the nerve was atrophied, but responding to such stimulation, neurolysis was decided to be the final step. Right carpal tunnel release done.

Routine closure of the wounds. Smooth postoperative recovery.

It hard to tell preoperatively, the exact nature of the lesion. Studying the nerve during exploration is the only solution to decide what best to the patient.